Educational Drive Cut Death Rate From Sepsis

TUESDAY May 20, 2008 -- A national education program in Spain to promote appropriate care for severe sepsis (bloodstream infection) and septic shock led to improved guideline adherence and a lower rate of sepsis deaths in hospitals, a new study says.

Severe sepsis accounts for one in five admissions to intensive care units and is a leading cause of death in non-cardiac ICUs, the study authors noted. In the United States, patients with severe sepsis have a death rate of 28.6 percent, or about 215,000 deaths a year.

In this study, researchers at the Universidad Autonoma de Barcelona examined the effect of a national education program based on the Surviving Sepsis Campaign (SSC) guidelines in 59 Spanish intensive care units.

The SSC -- developed as part of a plan to reduce deaths among patients with severe sepsis -- recommends implementing a six-hour resuscitation "bundle" (which includes a number of procedures and treatments), as well as a first 24-hour management bundle. There's been concern that the guidelines aren't being followed, possibly due to a lack of adequate health provider education.

The education campaign included training of doctors and other health workers in the definition, recognition, and treatment of severe sepsis and septic shock as outlined in the SSC guidelines.

In the 59 ICUs included in the study, patients with severe sepsis had a lower risk of hospital death after the education program (44 percent vs. 39.7 percent) and a lower 28-day death rate (36.4 percent vs. 31.1 percent).

In addition, compliance with all resuscitation and all management measures improved significantly after the education program.

"The decreased mortality observed in our study and other studies might derive from better identification of patients with severe sepsis or from improved compliance with quality indicators, including earlier administration of antibiotics, or both," the researchers wrote.

The findings are published in the May 21 issue of the Journal of the American Medical Association.

This study provides "powerful evidence that broad-based quality improvement in sepsis care is feasible on a national scale," Dr. Jeremy M. Kahn, of the University of Pennsylvania, and Dr. David W. Bates, of Brigham and Women's Hospital and the Harvard School of Public Health, wrote in an accompanying editorial.

"The data also suggest that delivering a bundle of care effectively for patients with sepsis may be as, or even more, important than developing new therapies. Indeed, the absolute risk reduction in hospital mortality observed in this study would translate to an impressive number of lives saved if this type of intervention were successfully implemented on an international scale."